Off the Charts Labor

Our culture loves charts and lists and dates to mark, and this love of regulation and planning has spilled into the way we treat pregnancy and birth. This is the cause of a great deal of stress and some very unhealthy attitudes.

Due dates, for instance, are a big deal to a lot of people. Many new moms find this frustrating in the extreme. Not only are they likely to begin hearing "You're HUGE!!! Haven't you had that baby YET???" starting sometime after 35 weeks, but if they happen to be in the percentage of women who do not have their baby by the 40 week mark, the pressure mounts. Every day past 40 weeks is another day for random strangers to comment on about the likely-hood of "popping". Every day past 40 weeks is another day for the liability-averse obstetrics culture to tell her all the ways her baby could be negatively impacted, or even killed, if he or she isn't soon rescued from that over-ripe womb. The fact is, only 5 percent of babies are born on their actual due date. If you do the simple math on that, you'll see that 95% of babies are not born on their due dates.¹ (That was just an exercise in the obvious, I know.) So why does that date on the calendar have such a huge, looming importance to us? Why is it so hard for us to accept that there is a 5 week range of normal for full term delivery, rather than a single date on which the baby "should" be born?

Just like we adore our growth charts and calendars for the rest of life, we like pregnancy and birth to go according to an orderly, plannable course. These thing have a level of usefulness, and there's nothing wrong with order and planning. But we must remember that nature doesn't actually operate on a rigid timetable. Both in and out of the womb, humans develop at slightly different rates. Some children crawl earlier, some later. Some read at 4, some at 7. Some grow quickly, some a little slower.

Some babies are ready to greet the world at 37 weeks, and some need to "bake" a little longer, say 42 weeks or even a few days past that.

Along with due dates, length of labor can be a big issue. The occasional mother might have a "textbook" labor when it comes to timing. But heaven forbid she deviate from the time-table. That, of course, calls for action, usually in the form of Pitocin. Or a cesarean section. But what of the perfectly healthy mother whose water breaks and she delivers a perfectly healthy baby some 30 hours later? And conversely, what of the mother whose labor is 4 hours start to finish? Neither one fits the "normal" labor pattern of a little more than 1 cm cervical dilation per hour², but both can have good, healthy deliveries resulting in healthy babies.

Some women will dilate faster, and some will dilate slower, and the occasional women will dilate right along the line dictated by the charts.

Is there a moral problem with planning birth and making it happen on a particular date? Not really. But there is sometimes an exchange of risks when we do this, which could have ethical implications depending on which way the risks fall. We all want the best for our babies. If overriding nature is a course we're considering, we need to weigh our preference for a particular date against the baby's health and needs. It may be miserable to be 38 weeks pregnant and looking at 3 more weeks of that, but it's entirely possible that the baby needs those last few weeks of development for their best start in life outside the womb.³ On the other hand, as 42 weeks approaches, the risk of the baby being born not fully developed is increasingly less, and the decision becomes more about the mother's preferences for labor and whether she is OK with elective interventions.

Regardless, we'd all benefit from letting go of our death grip on due dates and labor curves, and paying more attention to the individuals involved in the process--their unique needs, and unique risks, and the reality that nature cannot be confined to a chart or a date on the calendar.

¹What to expect after your due date, staff, ACOG
²Abnormal Labor, Joy/Scott/Lion, eMedicineHealth
³ Why the Last Weeks of Pregnancy Count, staff, March of Dimes